Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

Jennifer E Holland; Susan E Varni; Christian D Pulcini; Tamara D Simon; Valerie S Harder

doi:10.1016/j.jadohealth.2021.08.011

Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

J Adolesc Health. 2022 Jan;70(1):64-69. doi: 10.1016/j.jadohealth.2021.08.011. Epub 2021 Oct 6.

Authors

Jennifer E Holland¹, Susan E Varni², Christian D Pulcini³, Tamara D Simon⁴, Valerie S Harder⁵

Affiliations

¹ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont.
² The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont.
³ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Surgery at The University of Vermont, Burlington, Vermont.
⁴ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁵ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Psychiatry at The University of Vermont, Burlington, Vermont. Electronic address: Valerie.Harder@uvm.edu.

Abstract

Purpose: To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization.

Methods: Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity.

Results: Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19-1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01-1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26).

Conclusions: Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.

Keywords: Adolescents and young adults; Emergency care; Insurance; Medical complexity; Preventive visits.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Adult
Child
Emergency Service, Hospital*
Female
Health Facilities
Humans
Medicaid*
United States
Young Adult

Grants and funding

R03 HS024575/HS/AHRQ HHS/United States